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Monthly Archives: September 2011

to use Lovenox.

AGAIN!!!!

My hunch was right about having to wait for the doctor to review my results for this panel in comparison to my NKa (a nurse called me and left me a voice mail last week that my results were normal). I talked with the nurse on Tuesday and she said my APA results were in but they were waiting for the doctor’s review and she wouldn’t tell me if they were normal. However, it was not exactly the answer to my prayers.

Out of 21 elements the APA tests for, I only had 1 that was a borderline result (not quite positive, but not normal) while all the other 20 were “normal.” The nurse said my doctor would like to “add” baby aspirin to my chart as that is the common treatment for a borderline result.

This of course sent me off the deep end only for 2 reasons.

#1 I AM ALREADY ON A DAILY FUCKING BABY ASPIRIN YOU MOTHER EFFER-did you not read my file?????????

#2 I WAS TAKING A DAILY FUCKING BABY ASPIRIN FOR EVERY SINGLE ONE OF MY MISCARRIAGES, SO THIS IS CLEARLY NOT THE MISSING LINK!!!!!!!

Great. Real fucking great.

As I’m sure you all remember, I met with a vascular specialist this month and discussed Lovenox, and she said-I think it can’t hurt so I will let Lizzie know that I approve a prescription for you if you would like one. However, Lizzie isn’t running this cycle, and her apprehension to write an RX for Lovenox has been made abundantly clear-and now that I took my ball and went to play with another RE, there is no way in fucking hell Lizzie will write me a prescription for Lovenox for an IVF cycle and or pregnancy that she had no hand in.

So I told the nurse, I am already on baby aspirin (as I am sure you noted this from my file), and have miscarried 6 babies while on baby aspirin so I have gone through the pain staking process of meeting with a vascular specialist to confirm that I can take lovenox-and as a matter of fact, ALREADY HAVE A MONTHS WORTH OF THIS DRUG AND I WILL BE TAKING IT DURING MY 2 WEEK WAIT OF THIS IVF CYCLE. And the nurses response was “Oh, well Dr. P. doesn’t typically prescribe Lovenox for results like these, you will have to meet with him to discuss this.”

Great. Real fucking great.

“Umm you’re not hearing me. Using Lovenox isn’t up for debate, I just need you to inform him I am going to be taking Lovenox and have him sign off on my prescription please.”

“I can’t do that, you will have to talk with him.”

Great. Real Fucking Great.

Arrrrgggggggggggggggghhhhh!! And yet another appointment I have to wait for, and AGAIN beg for Lovenox.

Me: Lizzie, we are very upset. We don’t understand why we had such a low and horrible response after being on birth control pills for 2 weeks and then coming off of BCP’s and 2 days later beginning to take both menopur and follistim daily for 14 days. This is way longer and far more drugs than last time and we actually made LESS mature eggs, had a LOWER fertilization rate and had LESS embryos than when we came off of a natural cycle and just FSH stimmed for 12 days last October. We were expecting since this was a PLANNED IVF cycle-it wasn’t an IUI conversion cycle like our first time- that we would have made twice the eggs. You said our goal was 20 follicles so we would have enough embryos to make paying for PGS worth the money-we just don’t understand how we could have fallen so far short with only 8 mature follicles after all of that-what went wrong??

Lizzie: YOU are a very unpredictable patient to stimulate. Sometimes this just happens.

Meanwhile….across town, Dr. Sher is writing this memo for his blog:

Birth Control Pill Prior to IVF – Detrimental or Beneficial?

Various sources have stated that it is not a good idea to take birth control pills before IVF – or before starting controlled ovarian stimulation (COS) in a cycle of IVF. The reason quoted is that it can suppress the development of ovarian follicles, prolong the stimulation regimen, and negatively impact egg/embryo quality. This is only half of the story and therefore renders this line of reasoning incorrect.

It is a fact that if a woman goes directly from Birth Control Pills to ovarian stimulation without overlapping the last several days on the pill with a GnRH agonist (GnRHa) such as Lupron, Nafarelin, or Buserelin, this can negatively affect the stimulation. However, if GnRHa is given for the last 4-6 days on the Pill prior to beginning COS with gonadotropins, this will NOT be the case. Let me explain why:

Toward the end of a natural ovulation cycle, beginning several days prior to menstruation, the corpus luteum (the structure that produces estrogen and progesterone after ovulation) starts to fail. At the same time, blood levels of follicle stimulating hormone (FSH) begin to rise, which triggers the final process of egg recruitment and antral follicle development. Absent this FSH triggering, egg and follicle preparation are more likely to be compromised.

The mechanism of action of the birth control pill (BCP) is through suppression of FSH release by the pituitary gland, blocking ovulation and preventing formation of the corpus luteum.

The problem occurs when a woman is on BCP and immediately begins ovarian stimulation upon menstruation following discontinuation of the pill. In this case, she would be initiating the stimulation without allowing the process of egg recruitment and antral follicle development to be completed. As a result, follicular response to the stimulation will usually be delayed and blunted. In the process, follicle and egg development are often compromised, and the length of the ovarian stimulation cycle is prolonged significantly. This helps to explain why there is a perception that the birth control pill can be detrimental to IVF outcome. In reality, it is only the case when ovarian stimulation is initiated immediately following discontinuation of the pill.

In my opinion, it is not only acceptable, but even desirable to take the birth control pill for at least one cycle prior to starting ovarian stimulation for in vitro fertilization. This allows the patient to better plan and time her IVF treatment.

Additionally, since the birth control pill also suppresses LH, it can be very helpful in older women, in those with diminished ovarian reserve, and in those with Polycystic Ovarian Syndrome (PCOS). In the latter, high LH levels can negatively impact egg/embryo quality).
The bottom line is that the use of a birth control pill to prepare for an IVF cycle should always be overlapped with a GnRHa for several days before ovarian stimulation begins. If this is done, the pill will NOT suppress or compromise response to COH.

Fuck you Lizze.

I can’t believe you blamed ME! Seriously? Im an unpredictable patient to stimulate??

Not only is the calendar ready, its ready a day early and it’s AWESOME.

This takes anal retentiveness to a whole new level and totally puts my tracking to shame. Even better-no effing guessing!!!

No more last minute Bullshit!!!!

I know exactly what days (RIGHT NOW!!! a whole month in advance) that I need to schedule my clients around so that I can go in early for blood work/ultrasounds for the entire cycle.

I have the day of egg retrieval nailed down to a 48 hour window! Seriously boys and girls, this is exactly what I meant when I mentioned SIRM understands the little things that drive us patients nuts (and for no good reason really).

I will find out this week the results of the last outstanding immune panel and am praying that there are some answers there and not another “normal” label. Please no normal. Please, please, please, baby jesus, oprah winfrey and tom cruise-please tell me there is something not normal to validate all of my dead babies.

Of all the panels to have issues with, this is the one. It is the cheapest to fix with drugs that are actually covered under my plan and women with APA issues, once corrected with steriods and lovenox, typically go on to carry to term LIVE HEALTHY BABIES! Oh em gee-what the hell is that? I have no idea-wouldn’t even be able to wrap my mind around that concept really.

However, let it be known, that I am bracing for the impact of the “normal” results because I did have a portion of this panel done in June (through a lab that wasn’t nearly as thorough) and they said I had no issues in this area. Please let that not be the case. Please let them be wrong. Please let there be something simple that is messed up with me rather than rotten eggs. Because if this comes back normal-all that is left is the fact that I most likely make rotten eggs. And not just a few-but a shit ton of rotten eggs. Dealing with the fact that all of my eggs are shit will be a blow that will bring me to my knees both physically and emotionally.

The other thing that makes this week big stuff-I just got an email from SIRM (on a sunday!?) that I will also get my drug and appointment calendar on Tuesday. Hooooray I finally get to take a look at the protocol that SIRM thinks is the ticket to making a good quantity of high quality eggs given my history. Because as I am beginning to learn through this process of multiple IVF fails-it isn’t just that you are doing IVF-it is actually PARAMOUNT that you are given the right drugs at the right time based upon your hormone levels that will create more and higher quality eggs. A protocol that works for me, will not work for someone else. And it also explains why my yield of eggs on my last IVF cycle was so fucking lousy, and our fertilization rate of those eggs dropped in comparison to my egg quantity and quality of my IUI converted to an IVF cyle.

Bad job lizzie. Using birth control pills to “supress” me for 2 weeks and then going directly into stimulation without overlapping lupron and birth control pills prior to stimulation= a low yeild of rotten eggs. How do you not know that??? Why did I not research this before agreeing to that protocol?? I’m so fucking stupid. But seriously Lizzie, you are the doctor here, why would you ever suggest that protocol given the fact that my FSH is 11 and I have failed ART cycles and am a habitual aborter???

Oh yeah, that’s right because you’re a fucking asshat and I want to punch you in the ovaries.

On a side note, I have begun to really appreciate the little things that make my life easier during an IVF cycle and love that so far SIRM has figured this out too. You come to appreciate it when someone is looking out for you when you ass has been left hanging in the breeze.

I didn’t have to explain to SIRM that cigna teldrug sucks and beg the nurse scheduler to put my drug order in ASAP-because as soon as she saw Cigna, she knew what kind of shenanigans they pull and thus said (before I could tell her) “I noted that you use teldrug. So we are going to place your med order immediately as well as over order meds (just to make sure that you don’t run out last minute) because it takes a long time to get through teldrug hoops and our patients were going through too much unnecessary stress trying to get the drugs they needed and in time-which is the antithesis of what an IVF patient should be doing days before retrieval.”

Not counting of course the obvious most suckiest part (no children) of recurrent pregnancy loss coupled with primary infertility- there are two other very lousy things that I can’t escape lately.

The first being that once you’ve gone through IVF (multiple times) and a FET and come out the other end with no healthy take home baby you lose the ability to have hope that future cycles will bring one home either.

I mean why would they??

Why should I believe or have faith that another medicated cycle is going to do what the previous ones didn’t? Especially since I supposedly have nothing wrong with me so its not like I was broken before but have since been fixed so the IVF result will be different. Having hope and faith and belief that this time it will be different, in my mind, just sets me up for mental devastation for when I miscarry or get a BFN.

Have you any idea how effing hard it is to walk around for 2 weeks and just know you are pregnant, to just know this worked because you have hope and you did the thing that is the most advanced way to get you pregnant and then have that just crushed?

Time,

after time,

after time,

after time,

after time,

after time??????

No I doubt it, because that’s a special layer of hopeless hell that should only be reserved for the likes of Casey Anthony. And yet here I am down here so buried by past failures I have no ability to feign hope, nor the will power to want to hope any more. I’m not sure why people feel the need to tell me I have to have hope and believe, I suppose because at the end of the cycle it isn’t their heart being ripped out and stomped on?

Here’s the truth-hope hurts me. Hope hurts me while doubt keeps my heart protected. Let me have that. Don’t make me feel bad because I guard my heart with cautious doubt. Yes I know that feeling this is sucky. And this is why it is ranked so high in the “things that suck the most about this” list.

The second most sucky thing about this? I hate my lady business. I have a seething hatred for it. I want nothing to do with it. I would like to rip it out and stomp on it and set it on fire. The idea of attempting to derive pleasure from this bitch is nauseating. In my mind, if I am using her for “pleasure” she is enjoying it too and that is unacceptable.

She should enjoy nothing.

And geesh, what wonders this top ranked sucky thing has done for my libido.